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目的探讨不同形态滤过泡对青光眼患者眼表结构和舒适度的影响。设计前瞻性病例系列。研究对象滤过性手术成功并完成术后6个月随访的青光眼患者44例。方法采用手术前后的自身对照方法,通过问卷调查、眼表结构检查及裂隙灯显微镜滤过泡照相,比较滤过泡的存在及其不同形态引起青光眼患者眼表结构和舒适度的变化。主要指标问卷调查、角膜荧光素染色、结膜虎红染色、泪液分泌试验(Schirmer值)、泪膜仪脂质层测量、泪膜破裂时间(BUT)、角膜对称性指数(SRI)、角膜不规则指数(SAI)和角膜潜在视力(PUV)。结果滤过泡眼眼部畏光感和干涩感的发生明显增高(P=0.02,0.000),眼部不适感评分显著升高(P=0.000),荧光素染色、虎红染色、泪膜仪分级、SRI和SAI均较术前显著增高(P值均=0.000),PUV和BUT较术前显著减小(P=0.000),Schirmer值无显著变化(P=0.417)。患者年龄和性别与术后滤过泡形态及眼表结构和舒适度的变化程度无显著相关性。薄壁滤过泡组患者畏光感加重明显(P=0.002),厚壁滤过泡组患者干涩感加重突出(P=0.003)。薄壁滤过泡组术后虎红染色评分、泪膜仪评级增加程度及BUT缩短程度均较厚壁滤过泡组明显(P=0.046,P=0.032,P=0.024),而厚壁滤过泡组则以Schirmer值减小更为显著(P=0.027)。结论滤过术后晚期,滤过泡的存在破坏眼表结构,引起患眼明显的不适症状。薄壁滤过泡主要引起眼部刺激症状及角结膜组织结构的损害,厚壁滤过泡主要引起眼部干涩感及泪液量的减少。
Objective To investigate the effects of different forms of filtration bleb on ocular surface structure and comfort in patients with glaucoma. Design prospective case series. Forty-four patients with glaucoma who underwent successful surgeries and were followed up for 6 months were included in this study. Methods Before and after surgery by self-control method, through questionnaire survey, ocular surface structure examination and slit lamp microscopy bleb photography, compared the presence of different filtering bleb and glaucoma ocular surface structure and comfort changes. Key indicators questionnaire, corneal fluorescein staining, conjunctival tiger red staining, tear secretion test (Schirmer value), tear film instrument lipid layer measurement, tear film break-up time (BUT), corneal symmetry index (SRI), corneal irregularities Index (SAI) and Corneal Potential Vision (PUV). Results The incidences of photophobia and dryness were significantly increased in the eyes of the blinkers (P = 0.02, 0.000), the scores of the eye discomfort were significantly increased (P = 0.000), fluorescein staining, tiger red staining, The grade, SRI and SAI were significantly higher than those before operation (P = 0.000). The PUV and BUT were significantly decreased (P = 0.000) and Schirmer values were not significantly changed (P = 0.417). There was no significant correlation between patient age and gender and postoperative filtering bleb morphology and ocular surface structure and comfort. Patients with thin-wall blebs had significantly more photophobia (P = 0.002), and those with thick-wall blebs had significantly worse dryness (P = 0.003). The scores of post-operation tiger red staining, the increase of rating of tear film and the shortening of BUT in the thin-wall blebs were significantly higher than those in the thick-wall blebs (P = 0.046, P = 0.032, P = 0.024) The Schirmer value decreased more significantly in the over-blister group (P = 0.027). Conclusion Late filtration, the presence of filtered bleb damage ocular surface structure, causing obvious symptoms of eye discomfort. Thin-walled filtration bleb mainly caused eye irritation and damage to the structure of the cornea and conjunctiva. The thick-wall bleb mainly caused the dryness of eyes and the decrease of tear volume.